The consultation process is the core of our subspecialty. It is a challenging and complex exercise in which the Consultation-Liaison Psychiatrist (1) evaluates the consultation question and considers the possibility of manifest and latent content and questions, (2) thoroughly reviews the chart and creates a hypothesis, (3) interviews the primary care team and the patient, and, if appropriate, family or other sources of information (4) formalizes the assessment and recommendations. This process demands many skills, including the ability to analyze and summarize extensive amounts of clinical information, to thoroughly evaluate the patient, and finally to make recommendations based on the compounded data obtained during the interviews and through the review of the clinical information, always supported by the knowledge of both psychiatric and medical determinants, and keeping in mind the expectations and fears of the both the patient and the primary team.
In this symposium, we will review the aspects of the “excellent consultation,” using HIV/AIDS as a model. We will also discuss how to approach a new diagnosis of HIV, as patients often have many questions about the diagnosis, life expectancy, treatment options, prevention, and implications for their mental and physical health.
Dr. Swenson will start by introducing a real-life psychiatric consultation requested for a patient who was hospitalized with Shigella-associated gastroenteritis and found to have anxiety. Dr. Swenson, a C-L psychiatry resident, reviewed the chart before seeing the patient and found that patient’s admission laboratory testing revealed a positive test for HIV. Dr. Swenson will also highlight the liaison components of the consultation process.
Dr. Pereira will review the basics of HIV infection that are essential to a C-L Psychiatrist, including its history, social stigma, changes in life expectancy and quality of life, the latest guidelines in HIV treatment as well as the most common neuropsychiatric side effects of antiretrovirals.
Dr. Reza will follow, focusing on the clinical interaction with the patient and reviewing important concepts such as informed consent, techniques for delivering difficult news, and highlighting the importance of the neurocognitive exam. She will also discuss different approaches the C-L Psychiatrist can use to support medical colleagues in the care of patients newly diagnosed with HIV infection.
Dr. Wai will review the main drug interactions between the most commonly prescribed antiretrovirals and psychiatric medications.
Discussion will include questions and answers as well as role play.